Ultrasound Boosts Nodal Staging Accuracy in Lung CA

by John Gever John Gever,Senior Editor, MedPage Today
November 23, 2010

Action Points

Explain that more nodal metastases were detected in patients with non-small cell lung cancer (NSCLC) when surgical staging was supplemented with endosonography compared with surgical staging alone.

Note that this procedure decreased the number of unnecessary thoracotomies.

More nodal metastases were detected in patients with non-small cell lung cancer (NSCLC) when surgical staging was supplemented with endosonography compared with surgical staging alone, according to results of a randomized trial.

The multicenter trial of more than 240 NSCLC patients found that the sensitivity for mediastinal nodal metastasis detection was 94% with the combined approach (95% CI 85% to 98%) versus 79% for surgical mediastinoscopy alone (P=0.02), reported Jouke T. Annema, MD, PhD, of Leiden University in The Netherlands, and colleagues.

The combination also cut down on unnecessary thoracotomies, Annema and co-authors wrote in the Nov. 24 issue of the Journal of the American Medical Association. Only 7% of lung cancer patients in the combination group underwent thoracotomies that proved unnecessary -- compared with 18% of the NSCLC patients who underwent surgical detection (P=0.02), the researchers said.

"This benefit is not associated with a greater rate of complications," Annema and colleagues added.

Radiographic imaging followed by mediastinoscopy is the current standard of care in searching for nodal metastases in patients with resectable NSCLC, the researchers explained.

Seven patients who had mediastinoscopy alone experienced significant complications versus six in patients in the combination group. Of the total 13 adverse events, six were persistent hoarseness. Others included major bleeding, pneumothorax, mediastinitis, and conversion to thoracotomy.

In an accompanying editorial, Mark D. Iannettoni, MD, MBA, of the University of Iowa in Iowa City, said the findings appeared solid -- but he questioned whether they would translate easily to routine clinical practice.

"The study ... was based at a tertiary referral center where the level of expertise in endoscopic techniques is probably much higher than at community hospitals where the majority of thoracic surgery procedures take place. This fact is extremely important because these modalities are highly operator dependent," Iannettoni wrote.

He also emphasized the study finding that endosonography by itself did not improve very much on using mediastinoscopy alone, making the continued use of mediastinoscopy essential to achieve significant sensitivity gains.

Internal funds and British government grants funded the study. Hitachi Medical Systems and Olympus provided training and/or equipment used in the study.

The authors and editorialist reported they had no financial conflicts of interest.